小儿支气管异物取出术1例的麻醉管理分析

Analysis of Anesthesia Management for Removal of Bronchial Foreign Body in a Child

摘要: 病史摘要：气道痉挛和低氧血症是小儿气道异物取出术常见的并发症，本病例报道一例3岁的支气管异物小儿患者行硬质支气管镜后发生气道痉挛和低氧血症，后改为可弯曲支气管镜诊疗的病例。症状体征：其家属代诉患儿食入腰果后当即出现剧烈咳嗽，伴憋气，后出现呕吐3次，呕吐物为胃内容物，家属当即行“海姆立克急救法”，未见有异物咳出，持续约40分钟后憋气缓解，后间断咳嗽1 d，无咳痰，无憋喘等症状。诊断方法：胸部CT显示右侧叶支气管分叉处异物，大小约1.0*0.9 cm，右肺阻塞性肺气肿，余气管支气管未见明确异常，诊断为支气管异物、肺气肿(右)。治疗方法：支气管镜异物取出术。临床转归：异物取出后，患儿气管官腔通畅。术后抗感染等对症治疗且无气道痉挛和低氧血症发作，患者预后良好。

Abstract: Medical history abstract: Airway spasm and hypoxemia are common complications of airway foreign body removal in children. This case reports a 3-year-old child with bronchial foreign body who developed airway spasm and hypoxemia after rigid bronchoscopy, and was treated by flexible bronchoscopy. Symptoms and signs: The family members complained that the child had severe cough immediately after eating casheosa, accompanied by shortness of breath, and then had vomiting for 3 times, and the vomit was stomach contents. The family members immediately performed the “Heimlich first aid” method, and no foreign body was coughed out. After about 40 minutes, the breath was relieved, and then the child coughed intermittently for 1 day, without expectoration or choking. Chest CT showed a foreign body (1.0*0.9 cm) at the bifurcation of the right bronchus, with obstructive emphysema in the right lung, and no clear abnormalities in the rest of the tracheobronchus. The diagnosis was bronchial foreign body and emphysema (right). The treatment was bronchoscopic foreign body removal. Clinical outcome: The tracheal lumen was patent after removal of the foreign body through bronchoscopy. Postoperative anti-infection and other symptomatic treatment without airway spasm and hypoxemia attack, the patient has a good prognosis.